Management of the incidental pulmonary embolism

American Journal of Roentgenology

Volumn 208, Issue 3, 2017, Pages 485-488

  Chiu, Victor ^a   O'Connell, Casey ^a  

^a UNIVERSITY OF SOUTHERN CALIFORNIA   (United States)

Author keywords

Incidental; Management; MDCT; Pulmonary embolism; Unsuspected

Indexed keywords

ANTICOAGULANT AGENT; D DIMER; PHENYLBUTAZONE;

ANTICOAGULANT THERAPY; COMPUTED TOMOGRAPHIC ANGIOGRAPHY; DEEP VEIN THROMBOSIS; ECHOGRAPHY; FALSE NEGATIVE RESULT; FALSE POSITIVE RESULT; HUMAN; INCIDENCE; INCIDENTAL PULMONARY EMBOLISM; INTENSIVE CARE; LUNG ANGIOGRAPHY; LUNG CANCER; LUNG EMBOLISM; MORTALITY RATE; MULTIDETECTOR COMPUTED TOMOGRAPHY; OVERALL SURVIVAL; PREVALENCE; REVIEW; SEGMENTAL PULMONARY EMBOLISM; VENOUS THROMBOEMBOLISM; DIAGNOSTIC IMAGING; EVIDENCE BASED MEDICINE; INCIDENTAL FINDING; PRACTICE GUIDELINE; PULMONARY EMBOLISM; STANDARDS; TREATMENT OUTCOME; UNITED STATES;

ANTICOAGULANTS; COMPUTED TOMOGRAPHY ANGIOGRAPHY; EVIDENCE-BASED MEDICINE; HUMANS; INCIDENTAL FINDINGS; PRACTICE GUIDELINES AS TOPIC; PULMONARY EMBOLISM; TREATMENT OUTCOME; UNITED STATES;

EID: 85013657817     PISSN: 0361803X     EISSN: 15463141     Source Type: Journal    
DOI: 10.2214/AJR.16.17201     Document Type: Review

References (50)

1. O'Connell C. How I treat incidental pulmonary embolism. Blood 2015; 125:1877-1882
2. Carrier M, Righini M, Wells PS, et al. Subsegmental pulmonary embolism diagnosed by computed tomography: Incidence and clinical implications- systematic review and meta-analysis of the management outcome studies. J Thromb Haemost 2010; 8:1716-1722
3. Le Gal G, Righini M, Parent F, van Strijen M, Couturaud F. Diagnosis and management of subsegmental pulmonary embolism. J Thromb Haemost 2006; 4:724-731
4. Dentali F, Ageno W, Becattini C, et al. Prevalence and clinical history of incidental, asymptomatic pulmonary embolism: A meta-analysis. Thromb Res 2010; 125:518-522
5. Liebman HA, O'Connell C. Incidental venous thromboembolic events in cancer patients: what we know in 2016. Thromb Res 2016; 140(suppl 1):S18-S20
6. Patel S, Kazerooni EA, Cascade PN. Pulmonary embolism: Optimization of small pulmonary artery visualization at multi-detector row CT. Radiology 2003; 227:455-460
7. Khorana AA, O'Connell C, Agnelli G, Liebman HA, Lee AY; Subcommittee on Hemostasis and Malignancy of the SSC of the ISTH. Incidental venous thromboembolism in oncology patients. J Thromb Haemost 2012; 10:2602-2604
8. Lee EY, Kritsaneepaiboon S, Arellano CM, Grace RF, Zurakowski D, Boiselle PM. Unsuspected pulmonary emboli in pediatric oncology patients: Detection with MDCT. AJR 2010; 194:1216-1222
9. Schramm D, Bach AG, Meyer HJ, Surov A. Thrombotic events as incidental finding on computed tomography in intensive care unit patients. Thromb Res 2016; 141:171-174
10. Gandhi R, Salonen D, Geerts WH, Khanna M, McSweeney S, Mahomed NN. A pilot study of computed tomography-detected asymptomatic pulmonary filling defects after hip and knee arthroplasties. J Arthroplasty 2012; 27:730-735
11. den Exter PL, Kroft LJ, van der Hulle T, Klok FA, Jiménez D, Huisman MV. Embolic burden of incidental pulmonary embolism diagnosed on routinely performed contrast-enhanced computed tomography imaging in cancer patients. J Thromb Haemost 2013; 11:1620-1622
12. O'Connell CL, Boswell WD, Duddalwar V, et al. Unsuspected pulmonary emboli in cancer patients: Clinical correlates and relevance. J Clin Oncol 2006; 24:4928-4932
13. Donato AA, Khoche S, Santora J, Wagner B. Clinical outcomes in patients with isolated subsegmental pulmonary emboli diagnosed by multidetector CT pulmonary angiography. Thromb Res 2010; 126:e266-e270
14. Stein PD, Goodman LR, Hull RD, Dalen JE, Matta F. Diagnosis and management of isolated subsegmental pulmonary embolism: Review and assessment of the options. Clin Appl Thromb Hemost 2012; 18:20-26
15. O'Connell C, Razavi P, Ghalichi M, et al. Unsuspected pulmonary emboli adversely impact survival in patients with cancer undergoing routine staging multi-row detector computed tomography scanning. J Thromb Haemost 2011; 9:305-311
16. Rouzaud D, Alexandra JF, Chauchard M, et al. Incidental venous thromboembolism diagnosed in patients admitted with a first venous thromboembolism: Frequency and clinical significance (an observational study). Thromb Res 2016; 144:116-118
17. van der Hulle T, den Exter PL, Planquette B, et al. Risk of recurrent venous thromboembolism and major hemorrhage in cancer-associated incidental pulmonary embolism among treated and untreated patients: A pooled analysis of 926 patients. J Thromb Haemost 2016; 14:105-113
18. Ruiz Y, Caballero P, Caniego JL, et al. Prospective comparison of helical CT with angiography in pulmonary embolism: Global and selective vascular territory analysis-interobserver agreement. Eur Radiol 2003; 13:823-829
19. Ghanima W, Nielssen BE, Holmen LO, Witwit A, Al-Ashtari A, Sandset PM. Multidetector computed tomography (MDCT) in the diagnosis of pulmonary embolism: Interobserver agreement among radiologists with varied levels of experience. Acta Radiol 2007; 48:165-170
20. Brunot S, Corneloup O, Latrabe V, Montaudon M, Laurent F. Reproducibility of multi-detector spiral computed tomography in detection of sub-segmental acute pulmonary embolism. Eur Radiol 2005; 15:2057-2063
21. Bach AG, Meyer HJ, Taute BM, Surov A. The frequency of incidental pulmonary embolism in different CT examinations. Br J Radiol 2016; 89:20150737
22. Barritt DW, Jordan SC. Anticoagulant drugs in the treatment of pulmonary embolism: A controlled trial. Lancet 1960; 1:1309-1312
23. Carson JL, Kelley MA, Duff A, et al. The clinical course of pulmonary embolism. N Engl J Med 1992; 326:1240-1245
24. Linkins LA, Choi PT, Douketis JD. Clinical impact of bleeding in patients taking oral anticoagulant therapy for venous thromboembolism: A meta-analysis. Ann Intern Med 2003; 139:893-900
25. Nielsen HK, Husted SE, Krusell LR, Fasting H, Charles P, Hansen HH. Silent pulmonary embolism in patients with deep venous thrombosis: Incidence and fate in a randomized, controlled trial of anticoagulation versus no anticoagulation. J Intern Med 1994; 235:457-461
26. O'Connell CL, Razavi PA, Liebman HA. Symptoms adversely impact survival among patients with cancer and unsuspected pulmonary embolism. (letter) J Clin Oncol 2011; 29:4208-4209
27. Sun JM, Kim TS, Lee J, et al. Unsuspected pulmonary emboli in lung cancer patients: The impact on survival and the significance of anticoagulation therapy. Lung Cancer 2010; 69:330-336
28. Yoo HH, Queluz TH, El Dib R. Anticoagulant treatment for subsegmental pulmonary embolism. Cochrane Database Syst Rev 2016; CD010222
29. Ikesaka R, Carrier M. Clinical significance and management of subsegmental pulmonary embolism. J Thromb Thrombolysis 2015; 39:311-314
30. Wiener RS, Schwartz LM, Woloshin S. Time trends in pulmonary embolism in the United States: Evidence of overdiagnosis. Arch Intern Med 2011; 171:831-837
31. Carrier M, Righini M, Le Gal G. Symptomatic subsegmental pulmonary embolism: what is the next step? J Thromb Haemost 2012; 10:1486-1490
32. den Exter PL, van Es J, Klok FA, et al. Risk profile and clinical outcome of symptomatic subsegmental acute pulmonary embolism. Blood 2013; 122:1144-1149
33. Koch C, Schramm R, Roller FC, et al. Impact of unsuspected subsegmental pulmonary embolism in ICU patients. Anaesthesist 2016; 65:122-128
34. Wiener RS, Schwartz LM, Woloshin S. When a test is too good: How CT pulmonary angiograms find pulmonary emboli that do not need to be found. BMJ 2013; 347:f3368
35. Di Nisio M, Lee AY, Carrier M, Liebman HA, Khorana AA; Subcommittee on Haemostasis and Malignancy. Diagnosis and treatment of incidental venous thromboembolism in cancer patients: Guidance from the SSC of the ISTH. J Thromb Haemost 2015; 13:880-883
36. Kearon C, Akl EA, Ornelas J, et al. Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report. Chest 2016; 149:315-352
37. Jia CF, Li YX, Yang ZQ, Zhang ZH, Sun XX, Wang ZQ. Prospective evaluation of unsuspected pulmonary embolism on coronary computed tomographic angiography. J Comput Assist Tomogr 2012; 36:187-190
38. Shteinberg M, Segal-Trabelsy M, Adir Y, Laor A, Vardi M, Bitterman H. Clinical characteristics and outcomes of patients with clinically unsuspected pulmonary embolism versus patients with clinically suspected pulmonary embolism. Respiration 2012; 84:492-500
39. Sahut D'Izarn M, Caumont Prim A, Planquette B, et al. Risk factors and clinical outcome of unsuspected pulmonary embolism in cancer patients: A case-control study. J Thromb Haemost 2012; 10:2032-2038
40. Sijens PE, van Ingen HE, van Beek EJ, Berghout A, Oudkerk M. Rapid ELISA assay for plasma d-dimer in the diagnosis of segmental and subsegmental pulmonary embolism: A comparison with pulmonary angiography. Thromb Haemost 2000; 84:156-159
41. Eyer BA, Goodman LR, Washington L. Clinicians' response to radiologists' reports of isolated subsegmental pulmonary embolism or inconclusive interpretation of pulmonary embolism using MDCT. AJR 2005; 184:623-628
42. Franklin JM, Rahman N, Gleeson FV. The clinician's response to a report of an incidental pulmonary embolism detected on multidetector CT. Postgrad Med J 2011; 87:746-749
43. den Exter PL, Hooijer J, Dekkers OM, Huisman MV. Risk of recurrent venous thromboembolism and mortality in patients with cancer incidentally diagnosed with pulmonary embolism: A comparison with symptomatic patients. J Clin Oncol 2011; 29:2405-2409
44. Carrier M, Kimpton ML, Gal G, et al. The management of a sub-segmental pulmonary embolism: A cross-sectional survey of Canadian thrombosis physicians. J Thromb Haemost 2011; 9:1412-1415
45. Lim WY, Bozas G, Noble S, Hart S, Maraveyas A. Anticoagulating the subsegmental pulmonary embolism in cancer patients: A survey amongst different medical specialties. J Thromb Thrombolysis 2015; 40:37-41
46. den Exter PL, van Roosmalen MJ, van den Hoven P, et al. Physicians' management approach to an incidental pulmonary embolism: An international survey. J Thromb Haemost 2013; 11:208-213
47. Kearon C, Akl EA, Comerota AJ, et al. Antithrombotic therapy for VTE disease: Antithrombotic therapy and prevention of thrombosis, 9th ed-American College of Chest Physicians evidence-based clinical practice guidelines. Chest 2012; 141:e419S-e494S
48. Streiff MB, Holmstrom B, Ashrani A, et al. Cancer-associated venous thromboembolic disease, version 1.2015. J Natl Compr Canc Netw 2015; 13:1079-1095
49. O'Connell C. Incidentally found pulmonary embolism: what's the clinician to do? Hematology Am Soc Hematol Educ Program 2015; 2015:197-201
50. Abdel-Razeq HN, Mansour AH, Ismael YM. Incidental pulmonary embolism in cancer patients: Clinical characteristics and outcome- A comprehensive cancer center experience. Vasc Health Risk Manag 2011; 7:153-158